Healthcare Provider Details

I. General information

NPI: 1922937689
Provider Name (Legal Business Name): TIMOTHY JUSTIN WARREN LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MCNICHOLS RD
DETROIT MI
48203-2703
US

IV. Provider business mailing address

4416 COOPER AVE
ROYAL OAK MI
48073-1511
US

V. Phone/Fax

Practice location:
  • Phone: 313-867-8015
  • Fax:
Mailing address:
  • Phone: 313-867-8015
  • Fax: 313-867-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: